Doctors Target Virus as Link to Solve Polio-Like IllnessShannon Pettypiece
Amid fears of Ebola’s reach into the U.S., a more enigmatic virus is suspected of causing paralysis in dozens of children nationwide as doctors race to solve one of the most perplexing mysteries of their careers.
Enterovirus D68, which has hospitalized hundreds of children in almost every state and been linked to at least four deaths, may also have caused unexplained paralysis in cases from Boston to San Diego, doctors said. Researchers said they fear EV-D68 could be this generation’s version of polio, said Ben Greenberg, a Dallas-based neurologist.
Enterovirus typically causes only mild cold symptoms in most patients. Now, though, U.S. health officials are probing whether EV-D68 is directly linked to the paralysis. At the same time, more than 50 doctors at top U.S. hospitals are holding regular calls and pooling research, seeking to pinpoint physical changes that may lead to a treatment or a vaccine.
They are in a race against time as the EV-D68 outbreak has yet to wane. ‘We don’t want to repeat mistakes of history,’’ said Greenberg, of the University of Texas Southwest Medical Center. “If we could have accelerated the polio vaccine by a decade we could have saved a lot of people from the illness.”
Greenberg, who spoke by telephone, said he didn’t realize the full scope of the problem until early last week. After reports of a cluster of 10 paralysis cases in Colorado, he and 30 other neurologists, infectious disease experts and public health officials hastily organized a conference call Sept. 29.
To Greenberg’s surprise, almost every doctor on the call, from Boston to Chicago to Los Angeles, had seen at least one case of unexplained paralysis in the past several months, and some had seen as many as 10.
There have been 594 confirmed cases of EV-D68 in 43 states, beginning in the Midwest in August, according to the U.S. Centers for Disease Control and Prevention in Atlanta, though doctors said the number is probably far greater since not all those infected are tested.
Most only experience symptoms such as a runny nose, though a small percentage develop serious breathing difficulties, especially those with a history of such issues including asthma.
In cases where children develop paralysis, the symptoms usually start with those similar to a cold or stomach bug. They are followed by a fever, headaches, neck pain and, within a few days or weeks, a swift and sudden paralysis that in the most severe cases left children bound to a wheelchair, unable to speak or breathe on their own, said Keith Van Haren, a Stanford School of Medicine neurologist who has been studying a link between the virus and paralysis since 2012.
While there were some variations, most images from medical scans of those with paralysis looked strikingly similar, with the connection between the spinal cord and the muscles killed off with little chance of rebuilding the bridge -- just like seen in scans of those infected with polio, Greenberg said.
“There were remarkable similarities,” said Van Haren, who was also on the doctors’ conference call. “They sounded like interchangeable cases.”
The CDC hasn’t determined definitively whether the virus is causing the paralysis. EV-D68 hasn’t been detected in all of the paralyzed patients and given its widespread circulation, its presence could be coincidental, the agency said last week.
While the CDC continues to study the paralysis cases, “as a member of the clinical community, I think it is just a matter of time before we establish a definitive link between EV-D68 and this polio-like illness that follows,” Van Haren said.
New Jersey Case
The virus has also been documented in at least four deaths, the CDC said Oct. 1. Since then, New Jersey health officials have attributed the virus to the death of Eli Waller, a 4-year-old New Jersey boy who died suddenly in his sleep. Waller was kept home from school by his mother one day last month because he was developing a little bit of pinkeye, said Jeff Plunkett, the health officer for Hamilton Township where the boy lived. That night, he died in his sleep.
The Mercer County medical examiner’s office listed EV-D68 as the cause of death and found swelling of the brain and lymph nodes. He didn’t have any underlying medical conditions, such as asthma, said Plunkett.
There are currently no vaccines in development for the virus, which was rarely seen until this year. Before work on one can begin, researchers need more data to prove the virus is the cause of the paralysis, Greenberg said. Too often, samples aren’t taken in time to detect the virus and it’s possible multiple viruses may be to blame.
As of last week, the CDC has begun a national surveillance and testing program while Greenberg and other neurologists have formed a group to study patients more in depth.
The cases have doctors brushing up on their knowledge of polio, which hasn’t naturally occurred in the U.S. since 1979 after a vaccine was introduced in the 1950s. When Greenberg started seeing the polio-like cases, he called an older colleague at the National Institutes of Health who had trained in India to get a crash course on the disease and compare notes.
In contrast to enterovirus, there has been just one case so far of Ebola that was brought into the U.S. from a patient infected in Liberia. Though Ebola can be lethal, with a mortality rate in Africa as high as 60 percent, it is much less easily transmitted from person to person. Enterovirus is spread through casual contact, such as when an infected person sneezes or coughs while Ebola is only transmitted through the sharing of bodily fluids, like blood, vomit or saliva.
Carrie Baker-Bailey fears her son William, 8, is one of those who who may have lost the use of his arm. At the end of August she took him to the hospital near their San Diego home with neck pain, headache and a fever. An x-ray showed some inflammation in his chest and his doctor sent him home with antibiotics, Baker-Bailey said in a telephone interview.
Two days later he was feeling worse and had a stomach ache, was constipated and was complaining of pain all over his body. They went back to the hospital where doctors did a spinal tap, diagnosed him with spinal meningitis and sent him home.
That night, Baker-Bailey said she remembers him screaming in pain as he lay with her at 3 a.m. trying to fall back asleep. The next morning she knew something wasn’t right and took him back to the hospital again. By then, he said he couldn’t move his arm.
An MRI showed inflammation of his spinal cord and he was admitted to the hospital where he spent 13 days in the intensive care unit. He tested positive for enterovirus though doctors never did further testing to determine which of the more than 100 types of enterovirus he had.
Now, back at home, he still can’t lift or move his arm and has weakness in his back. The once-active little boy who played baseball year-round and swam competitively now has difficulty sitting up on his own in a chair, can’t dress himself and hasn’t been able to start the third grade.
Baker-Bailey thinks the virus had something to do with her son’s paralysis, but doctors haven’t been able to give her a clear answer for what caused it or whether he will ever regain use.
“How did he get it, what did he even have, and is it ever going to get better, we don’t have any answers,” she said. “Sitting in the ICU for 13 days asking why? Why? Why? And not having any answers, that has been the hardest part.”
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